Sunday, 13 October 2013

Sleepless in London

● Jon Danzig couldn't sleep during his overnight sleep testPhoto by David Mansell The Guardian

The average Briton only sleeps six-and-a-half hours a night. It's not enough.

Last week BBC TV broadcast an experiment showing that such little sleep can lead to less mental agility,
more stress, and a possible risk of cancer and diabetes. Volunteers underwent overnight sleep
tests for the BBC, and demonstrated that just one extra hour of shut-eye each night
can considerably improve health.

I had an overnight
sleep test at one of London’s most prestigious hospitals. It was a comical disaster and I didn't sleep a
wink. That's because the machinery to test if I snored was louder than my snoring.

This was no ordinary hospital. My sleepless overnight sleep test took place ten
years ago at the world famous King Edward VII, the exclusive medical
establishment in London attended by the Queen, the Duke of Edinburgh, Prince Charles, the Duchess of
Cambridge, and top military brass.

(Except in my case I was admitted only as a ‘category
four patient’ – meaning an ordinary
member of the public.)

Persevere

I complained. But after two 'extensive' investigations by the hospital and
months of correspondence, the King Edward VII couldn't find anything wrong. Well, I've learnt in life that sometimes you have to persevere. If you know in your heart that something is
wrong and needs to be put right, don’t give up.Intervention might save lives.

I catalogued a list of complaints. The hospital didn't deny my
version of events, but still they
couldn't find anything amiss. This seemed bizarre.

Under the Data Protection Act, I obtained their medical
records about me. I then began to realise that the word 'bizarre' was totally inadequate. I wrote back the same day:

'Your hospital's record of
my admission does not give me confidence in the abilities of your
organisation. My height was incorrectly
recorded, as was my weight and my age.

'Most alarming, however, was your
hospital's medical note that my testicles had been removed. I can only be thankful that in the
circumstances I did remain awake. Heaven
knows what else might have happened had I fallen asleep. I can assure you that I am entirely
complete.'

Never accuse Jon Danzig of having
no balls! This was now war.

Back came the hospital’s
reply. They agreed my testicles were
intact. The medical entry, they now
explained, stated a small lump (lipoma) had been removed from my
testicles.

Yet this too was wrong.

I got out a magnifying glass for
a closer look (at my medical records).It then all became clear. A lump had been removed some years earlier
from my back. But the nurse had written what looked like 'balls' instead of 'back'.Then another nurse crossed out the word 'balls' and wrote 'testicles'.

This was becoming one almighty cock-up.

Action only came when I fired a
missive telling-all to the hospital’s then top man, the Brigadier Colin Harrisson,
OBE.

Thank goodness he didn't just
sleep on it. Immediately he suspended all sleep tests at the hospital,
ordered a review, admitted the hospital had been wrong, apologised, refunded my
money and paid compensation. In my opinion the Brigadier
Harrisson was an officer and a gentleman.

Out-of-body

My doctor had ordered an
overnight sleep study because sometimes I snored and stopped breathing in my sleep, a condition called 'sleep apnoea'. I also experienced strange out-of-body experiences.

At 11 pm, when I was ready to
snooze, the nurse didn't know how to set up the computer properly. She started banging it and asked me if I knew
how it worked. I didn't.

She then asked how tall I
was. I replied, '5’10'.

'What is that in centimetres?'

I didn't know.

She then asked my weight in kilograms which I
did know. Then I got into bed and was
tethered to various wires connected to the computer.

When I looked at the computer
screen, I saw that my height had been put down as '5'.

'What does that mean?' I asked the
nurse.

'That’s your height,' she
replied.

'But it says five. I am not five. What measurement is it in?'

'Centimetres.'

'You have told the computer that
I am just five centimetres tall?'

'I’m
sure it doesn't matter.'

'Doesn't
matter? What’s the point of the exercise
if it doesn't matter? You have told the
computer that I am 85 kilograms in weight and five centimetres tall. The computer will do its calculations based
on an extremely short but incredibly wide dwarf.'

The nurse pondered for a while,
then disconnected me from the computer, handed me a tape measure and stood me
against the wall.

I thought she was
going to measure me. But she said she
was busy.

Have you ever tried to measure
your height on your own? It was not
easy, especially at midnight, when I was supposed to be rested for an overnight
sleep study. But after eventually completing the exercise, the nurse reattached
me to the computer and told me, 'Go to sleep.'

Whooshing

I tried. I really tried. But 15 minutes later, there was a whooshing
noise, a constriction in my right arm and then another whooshing noise. It was the blood pressure cuff affixed to my
right arm. It was scheduled to go off
every 15 minutes through the night. I
can’t sleep through that!

What was I
supposed to do, have 14 minute naps interrupted by the snoring blood pressure
unit?

If that wasn't bad enough, every
ten minutes, the computer started to whistle at me. Maybe it got turned on by the thought of
being hooked up with an over-weight dwarf.

At 3 am the nurse came in again. 'Jonathan, are you asleep?' she asked.
Of course I wasn't. So she
started talking to me.

The next morning, bereft of
sleep, another nurse came in.

'Good
morning, Jonathan!' she exclaimed brightly.

Then she leaned over the bed and whispered, 'Jonathan, I've heard all
about your out-of-body experiences.'

'Oh
yes,' I replied.

She leaned over a little more. 'Can I ask you, Jonathan, why you came here for these tests?'

'Well,' I replied, 'I've often felt tired
and without much energy.'

She looked around to check that
no one else was in the room. She then
started to talk in a low, conspiratorial voice.

'I shouldn't be telling you this. But I know a bit about out-of-body
experiences,' she said. 'Let me give you
some advice. All that flying about at
night is bound to make you very tired.'

Evidence

Later on my doctor reported that
there was no evidence that I had sleep apnoea.
It made me realise what a joke some tests can be. There was no evidence of sleep apnoea that
night because there was no evidence of sleep.

The exercise had cost £400
($650). That was something else to keep
me awake at night.

I
now know that during sleep tests there should be no noisy equipment to wake up
the patient. And blood pressure
monitoring during the test is not even necessary.

I had expected better
from a hospital designed to cater for Royalty.

But the then Chief Executive of the King
Edward VII's Hospital, the Brigadier Colin Harrisson, OBE, personally wrote to me, 'I accept that the conduct of your sleep study was poorly managed. I have
suspended sleep studies in the hospital pending an internal review.'

Sleep Apnoea - what is it?

Sleep apnoea is a serious and
potentially life-threatening condition if untreated.

People with sleep apnoea snore and repeatedly stop breathing for ten seconds or more during their sleep, sometimes hundreds of times throughout the night. Mostly the patient is completely unaware they've stopped breathing so often, but their sleep is so disrupted that they can feel extremely tired the next day.

It's a common disorder, affecting about 4% of men and 2% of women. According to the National Institutes of Health, around 12 million Americans have sleep apnoea. Although sleep apnoea often results in snoring, not everyone who snores has sleep apnoea.

There are two types of sleep apnoea: the most common is called 'obstructive', where blocked airways restrict breathing; and the more rare apnoea is called, 'central', where a faulty signal from the brain interrupts breathing during sleep.

Unfortunately, because
of the lack of awareness by the public and healthcare professionals, the vast
majority remain undiagnosed and therefore untreated, despite the significant
consequences.

The disorder can cause high blood
pressure, stroke and other cardiovascular disease; memory problems; emotional instability; diabetes; weight gain; impotency and decreased libido; headaches; severe fatigue and daytime sleepiness. Untreated sleep apnoea can result in poor performance at work and car crashes, with drivers involuntarily falling asleep at the wheel.

A diagnosis of sleep apnoea that affects your ability to drive must by law be reported to the Driver and Vehicle Licensing Authority (DVLA).Fortunately, sleep apnoea can in most cases be successfully treated, after which the DVLA usually confirms that you may keep your driving license.

● A special face mask attached to a CPAP airflowdevice helps to prevent snoring and sleep apnoea. Photo courtesy of ResMed

Following my disastrous overnight sleep study at the King Edward VII hospital, I was able to have a more successful sleep test at home, using portable equipment. This confirmed that I had sleep apnoea.

Fortunately, a special mask I can wear at night has cured the problem. It may not seem very romantic, but then, there's nothing romantic about snoring. Since wearing the silent, unobtrusive mask every night, I've never snored or had sleep apnoea again, nor had any more out-of-body experiences.

Modern successful treatments for sleep apnoea have dramatically improved the quality of patients lives; made our roads more safe from over-tired drivers, and saved hundreds of thousands of marriages and relationships across the world.

10 comments:

A hilarious article but one that highlights a much under-diagnosed problem. Research shows central sleep apnea is common after head injury (around 20%) and delays recovery, but it is not mentioned in any of the guidelines on head injury produced by NICE and their Scottish counterpart SIGN.

A sad and woeful experience. Better suited for a TV sitcom than medicine. NOTE: In 2013, the researchers who published the original estimates of sleep apnea frequency (quoted by NIH) published an updated analysis reporting that sleep apnea is several times more common today - mostly explained by the increase in obesity. See. http://www.ncbi.nlm.nih.gov/pubmed/23589584

Thanks for this Jon. I have a friend who is enduring these same problems. The hospital were taking him in for an overnight this weekend but have now told him he can take a machine home instead. I think he will be relieved once he reads your article.

Well, what happened to me was hopefully unusual. However, I’d say an overnight sleep test at home is always better, because for the test to be valid it’s important to be able to get to sleep. That’s often not easy at hospital, even when things go well.

I had similar expereince during sleep test: I could not sleep and I developed an allergic reaction to the gel used to paste the leads on my face. I told the nurse immediately, I showed her the welts and swelling around my nose and eyes; yet she insisted the test should go forward. Big surprise--in the morning they told me they knew what to do for me--shedule another sleep test at their facility b/c I hadn't slept enough and they suspected I had an obstruction in my nasal passage (hello, nose swollen from allergic reaction to gel)! They never mentioned my tossing and turning due to joint pain (my original complaint, and I was later diagnosed with inflammatory arthritis). My doctor just guessed at my neck measurement ( over a certain size is an indication for sleep apnea, so he guessed I was just over that size). When I measured my own neck at home with a fancy tape measure, the doc was off by 2.5 inches, and I did not have that risk factor for sleep apnea...Because I admitted to snoring when I had a cold, the doctor said I snored habitually (another risk factor) although my husband and son say I don't snore. The doc said "husbands always lie about this to protect ladies' feelings." It was a bizarre experience.